Possible Knee Injury

Training Injuries
21

Exhibit Overtime:) In response to too many ORTHO’s are fallible blah blah I’d like a scan…
Rightttt since physical exam hasn’t been proven to be as good or better than MRI for the knee at all… … … …

“Abstract
PURPOSE:
The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making.
METHODS:
A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr’s test, Childress’ sign, and the Ege’s test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated.
RESULTS:
Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.
CONCLUSION:
These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear”

or how bout

“Abstract
The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.”

cuz its not like PEOPLE HAVE TO READ THE MRI OR ANYTHING, LIKE THAT MAKES A DIFFERENCE OR THE TYPE OF MACHINE, O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt

22

[quote]BHOLL wrote:
In response to the whole GPS analogy:
FACT? Not once, a proper physical exam is more accurate than MRI, especially for partial thickness tears. However it seems as if your responding to more of the construed picture your boy 56 x 11 is painting. The orignial response to OP’s question, >>>>IS THIS URGENT? No in fact it is not and despite any shoulder pathology, REST, NSAIDS, CUFF WORK, AND ROWS can be performed safely irrelevant to differential diagnosis.
[/quote]

First of all, just because CroatianRage and I happen to believe you to be an irresponsible little man who is now furiously trying to justify his recent errors does NOT make me his boy. And it does not make him my boy.

And secondly, you just CONTRADICTED YOURSELF.

Here is your quote:

“Not once, a proper physical exam is more accurate than MRI”

Yet you made several comments in this thread why imaging for trivium (who has to be shaking his head in disbelief how this is panning out) that MY RECOMMENDATION FOR IMAGING IS INCORRECT.

Do you see what happens when someone makes erroneous statements and is neither man enough to back out or offer a mea culpa? He - this would be YOU, btw - is so busy trying to justify his manure that he eventually stumbles.

And to follow up on this post, I bet I know what you’re going to say.

You’re probably going to say that the following statement was a bit of a typo on your part:

“Not once, a proper physical exam is more accurate than MRI”

You’re probably going to rely on the position that you MEANT to say the following:

‘a proper physical exam is more accurate than MRI’

Then why do we even have imaging systems as a diagnostic tool…?

Furthermore, your premise that all physical exams are more accurate than MRIs implies that all physicians are infallible all the time. This is a laughable concept.

And if these physicians are so accurate in their diagnosis, why don’t suggest to some of these injured posters such as the fellow in this thread

to get that in person exam? Why did you imply that your advice was all that he needed to know. Which, to reiterate, was completely off when the OP of that thread GOT AN MRI.

23

[quote]BHOLL wrote:

Exhibit Overtime:) In response to too many ORTHO’s are fallible blah blah I’d like a scan…
Rightttt since physical exam hasn’t been proven to be as good or better than MRI for the knee at all… … … …

“Abstract
PURPOSE:
The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making.
METHODS:
A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr’s test, Childress’ sign, and the Ege’s test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated.
RESULTS:
Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.
CONCLUSION:
These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear”

or how bout

“Abstract
The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.”

cuz its not like PEOPLE HAVE TO READ THE MRI OR ANYTHING, LIKE THAT MAKES A DIFFERENCE OR THE TYPE OF MACHINE, O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt

[/quote]

Classic, text-book troll technique. Offer up abstracts of studies that support his stance.

And note the juvenile way of patting himself on the back:

“O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt”

If you actually are an adult who earns a living as a physical therapist, you must lead one bitter life in which you can hide behind an internet persona and make these comments.

And the fact that you have this incessant need to be the absolute authority on topics in which other peoples’ long-term health is in question, you are a sad person indeed.

24

[quote]56x11 wrote:

[quote]BHOLL wrote:
In response to the whole GPS analogy:
FACT? Not once, a proper physical exam is more accurate than MRI, especially for partial thickness tears. However it seems as if your responding to more of the construed picture your boy 56 x 11 is painting. The orignial response to OP’s question, >>>>IS THIS URGENT? No in fact it is not and despite any shoulder pathology, REST, NSAIDS, CUFF WORK, AND ROWS can be performed safely irrelevant to differential diagnosis.
[/quote]

First of all, just because CroatianRage and I happen to believe you to be an irresponsible little man who is now furiously trying to justify his recent errors does NOT make me his boy. And it does not make him my boy.

And secondly, you just CONTRADICTED YOURSELF.

Here is your quote:

“Not once, a proper physical exam is more accurate than MRI”

Yet you made several comments in this thread why imaging for trivium (who has to be shaking his head in disbelief how this is panning out) that MY RECOMMENDATION FOR IMAGING IS INCORRECT.

Do you see what happens when someone makes erroneous statements and is neither man enough to back out or offer a mea culpa? He - this would be YOU, btw - is so busy trying to justify his manure that he eventually stumbles.

And to follow up on this post, I bet I know what you’re going to say.

You’re probably going to say that the following statement was a bit of a typo on your part:

“Not once, a proper physical exam is more accurate than MRI”

You’re probably going to rely on the position that you MEANT to say the following:

‘a proper physical exam is more accurate than MRI’

Then why do we even have imaging systems as a diagnostic tool…?

Furthermore, your premise that all physical exams are more accurate than MRIs implies that all physicians are infallible all the time. This is a laughable concept.

And if these physicians are so accurate in their diagnosis, why don’t suggest to some of these injured posters such as the fellow in this thread

to get that in person exam? Why did you imply that your advice was all that he needed to know. Which, to reiterate, was completely off when the OP of that thread GOT AN MRI.

[/quote]

Im just gonna point out how dumb some of the things your saying are:

Itis and cuff tear, I previously stated these are not mutually exclusive terms, an itis denoting acute inflammation can be and sometimes is caused by tearing or microtearing of muscle fibers

"Yet you made several comments in this thread why imaging for trivium (who has to be shaking his head in disbelief how this is panning out) that MY RECOMMENDATION FOR IMAGING IS INCORRECT.
"

Not sure what’s contradictory here, I’ve repeatedly stated imaging is not necessary and provided 2 studies to back my claim, 2 more than which you provided. Fact? Not once is in response to the GPS analogy, don’t see whats so confusing considering you literally retyped exactly what I wrote.

Why do we even have imaging as a diagnostic tool? hmmmm is it really that hard to figure out? It is for when the patient present with symptoms not consistent with physical examination and when patients are willing to undergo surgical intervention.

“Furthermore, your premise that all physical exams are more accurate than MRIs implies that all physicians are infallible all the time. This is a laughable concept.”

Nope, just Orthos the two studies I posted back that. And your view on MRI’s is highly simplistic, MRI’s (you haven’t even mentioned MRA), as they also require a high level of expertise to read and depend highly on the person reading them, therefore demolishing your entire argument of removing human error. Guess you thought you just send em on in the MRI and beep bop boo boo beep there ya go the computer says you ruptured your ACL.

25

You provided two abstracts of studies that, surprise surprise, support your stance on imaging.

And I use the term MRI fully knowing that there are other types out there. Do you fully differentiate EVERY single term that you use? Of course not.

And you fail - yet again - to convince me or anyone other objective person who is unfortunate enough to read your comments that your claims of physician’s testing being more accurate than imaging applies 100% percent of the time.

And yet that is precisely what you’re trying to convince people here. I fully stand by my statements that imaging - at the discretion of the people involved - can and should be used to confirm or refute what the manual testing revealed.

And of course it takes a skilled individual to read the results. I NEVER stated otherwise.

However, if it was my knee or shoulder or whatever body part that was injured, I personally am going to take advantage of it just in case the doc’s assessment was incorrect.

You - in your effort to spite me - have been desperately trying to sell the notion that these docs are perfect beings who never make mistakes.

And you can say all night long that itis and cuff tears are not mutually exclusive.

However - AND PAY ATTENTION HERE - tendonitis and tears are NOT always the one and the same.

So nice try at trying to cover up your previous mistakes.

26

[quote]56x11 wrote:

[quote]BHOLL wrote:

Exhibit Overtime:) In response to too many ORTHO’s are fallible blah blah I’d like a scan…
Rightttt since physical exam hasn’t been proven to be as good or better than MRI for the knee at all… … … …

“Abstract
PURPOSE:
The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making.
METHODS:
A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr’s test, Childress’ sign, and the Ege’s test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated.
RESULTS:
Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.
CONCLUSION:
These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear”

or how bout

“Abstract
The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.”

cuz its not like PEOPLE HAVE TO READ THE MRI OR ANYTHING, LIKE THAT MAKES A DIFFERENCE OR THE TYPE OF MACHINE, O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt

[/quote]

Classic, text-book troll technique. Offer up abstracts of studies that support his stance.

And note the juvenile way of patting himself on the back:

“O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt”

If you actually are an adult who earns a living as a physical therapist, you must lead one bitter life in which you can hide behind an internet persona and make these comments.

And the fact that you have this incessant need to be the absolute authority on topics in which other peoples’ long-term health is in question, you are a sad person indeed. [/quote]

Yes, of course you hate when people actually back their claims while disproving your clinical expertise. I mean who would like that.

27

[quote]BHOLL wrote:

Itis and cuff tear, I previously stated these are not mutually exclusive terms, an itis denoting acute inflammation can be and sometimes is caused by tearing or microtearing of muscle fibers

[/quote]

I’m going to point out, yet again, how silly you’re just making yourself look with this statement.

I did exactly what a layman would do when he is motivated to research for himself online the difference between a rotator cuff tear and rotator cuff tenditis.

So I typed in the keywords into a search engine and here are some of the first-page results:

“…Because the symptoms of shoulder tendinitis and rotator cuff tears overlap, imaging tests may be needed to make a diagnosis.”

I know it’s against T-Nation policy to link to other websites but I can assure you and everyone else the above quote was taken from another site.

Here’s another one from another site:

"A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.

X-rays of the shoulder may show a bone spur. They can be done in your doctor’s office.

If your doctor feels you may have a rotator cuff tear, you may have one or more of the following tests:

An ultrasound test uses sound waves to create an image of the shoulder joint. It can often show a tear in the rotator cuff. MRI of the shoulder may show swelling or a tear in the rotator cuff.

Sometimes, a special imaging test called arthrography is needed to diagnose a rotator cuff tear. Your doctor will inject contrast material into your shoulder joint. Then an x-ray, CT scan, or MRI scan are used to take a picture of it. Contrast is usually used when your doctor suspects a small rotator cuff tear."

And there are other examples. People just type in the keywords ‘tendonitis same as cuff tear’ and find this for themselves.

And note the common denominator here: after the manual testing, further imaging testing are often times the protocol.

And look here…irfhdah in the other thread stated the following:

[quote]irfhdah wrote:
My wife finally made me go get an MRI. The doctor said I have a less than 25% tear in my rotator cuff (it is right at the top of the subscapulus where it meets the superscapulus.
[/quote]

And - for trivium (who started this thread) - this has been my stance all along. Get the manual test and confirm or refute with further test.

Yet continue to argue - just to save face - that further tests are uncalled for and that the physician’s manual testing should be the final word.

Those who read the comments on this thread as well as the one created by irfhdah regarding his shoulder will see you for what you are.

I am increasingly convinced that you’re just some kid who has read an inordinate amount of literature on the subject and now wants to act like the King of this subforum OR you’re an adult whose life is so miserable that the only validation you get is blind obedience from everyone here.

Btw, keep spewing your ineffective comments. I’ll continue to respond. This thread will continue to get hits, stay on top of the active list, and more and more people will begin to see you for what you really are.

28

[quote]BHOLL wrote:

Yes, of course you hate when people actually back their claims while disproving your clinical expertise. I mean who would like that.

[/quote]

I’ve refuted every major argument you made. You clearly don’t see it but the objective individual will have a differing perspective.

And you’re going to try and brush under the rug just how infantile the following self-congratulatory nonsense would appear to everyone else…?

[quote]BHOLL wrote:

cuz its not like PEOPLE HAVE TO READ THE MRI OR ANYTHING, LIKE THAT MAKES A DIFFERENCE OR THE TYPE OF MACHINE, O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt
[/quote]

It bears repeating that the more you persist, the more you’re showing everyone who reads this that you’re either some kid or an adult whose life is so miserable that you need to validate yourself by trying to gather as many blind followers as possible on this subforum.

Well guess what? Your attempts here are proving just the opposite. Keep digging if you want.

29

[quote]BHOLL wrote:

[quote]56x11 wrote:

[quote]BHOLL wrote:

Exhibit Overtime:) In response to too many ORTHO’s are fallible blah blah I’d like a scan…
Rightttt since physical exam hasn’t been proven to be as good or better than MRI for the knee at all… … … …

“Abstract
PURPOSE:
The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making.
METHODS:
A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr’s test, Childress’ sign, and the Ege’s test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated.
RESULTS:
Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.
CONCLUSION:
These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear”

or how bout

“Abstract
The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.”

cuz its not like PEOPLE HAVE TO READ THE MRI OR ANYTHING, LIKE THAT MAKES A DIFFERENCE OR THE TYPE OF MACHINE, O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt
[/quote]

Classic, text-book troll technique. Offer up abstracts of studies that support his stance.

And note the juvenile way of patting himself on the back:

“O YAAAA IT DOESSSSSSS mmmmmm I likeeeeeyyy thatttttt”

If you actually are an adult who earns a living as a physical therapist, you must lead one bitter life in which you can hide behind an internet persona and make these comments.

And the fact that you have this incessant need to be the absolute authority on topics in which other peoples’ long-term health is in question, you are a sad person indeed. [/quote]

Yes, of course you hate when people actually back their claims while disproving your clinical expertise. I mean who would like that. [/quote]

And just how did you back your claims? By citing two abstracts from studies that happen to support your stance? Anybody with access to a search engine can do the same.

And I repeatedly showed how you have this need to come across as this authority figure. If the subject at hand did not happen to be other people’s long term health, I’d laugh and let it slide.

In your case, I have zero problems exposing you as someone who cuts corners in his professionalism (if indeed you are a practicing physical therapist; for all I know you could be a pt aide, a student, or a just someone who talks a good game).

Your flaw, as I’ve stated before, is that you have some insecure need to be viewed as the top authority figure in this subforum. People can easily read the earlier posts to see through your juvenile antics.

And NO professional physical therapist that I can think of goes around spewing online advice with the implication that it’s as good as a diagnosis. Damn good thing that irfhdah in the Shoulder Injury Identification thread actually listened to his wife and NOT you and got that MRI to confirm his exact condition.

So, yeah, keep trying to cover up your errors. It’ll just keep this thread at the top of the charts. And this doesn’t bother me at all. Quite the contrary. The more people that see you for what you really are, the better.

30

Wow, this got out of hand quickly. I guess I’ll only address one point because, to be honest, I stopped reading.

Plenty of people have been injured from improper ice use (falling asleep with ice packs on). How many people know how to effectively apply ice? Most laypeople I’ve had experience with think the longer the better. If I tell a patient to ice their knees and they get injured because I didn’t explain exactly how, and document it, then I am absolutely liable for that injury.

Even proper NSAID use can cause death, although it is very rare.

Assuming you are a health care professional, then you’re wrong about someone asking for help and if they take your advice it’s on them.

31

Did everyone survive the night?

I went to visit an orthopedic surgeon. When I told him I lift weights, he treated me like I was a moron, and even asked me “why would anyone want to do that?” He also asked my girlfriend “where did you find this guy?” When he decided that I wasn’t a surgical candidate, and that he couldn’t make a quick buck off of me he told me that I have “generalized ligamentous laxity,” chronic patellofemoral syndrome, and that I should never deadlift or squat to depth again (to cover his own ass). He didn’t do shit with his physical exam, and didn’t even refer me to PT or anything. Basically gave me a big fuck you and shuffled me out the door.

I called a sports medicine complex that has PT and an orthopedic surgeon who specializes in sports medicine. He said I need to have a referral. I went to see my PCP and he said that since I am an athlete he wants to help me fix everything up so I can go back to what I love. I am scheduled for an MRI and am pending a referral to the complex that has the PT and sports med surgeon.

Any simple PT advice would be excellent at the moment.

I have done light squatting, bodyweight squatting, and exercise bike work to keep it moving. Is there anything else you guys recommend that I do while I wait for evaluation?

Thank you for all the responses!

32

[quote]trivium wrote:
Did everyone survive the night?

I went to visit an orthopedic surgeon. When I told him I lift weights, he treated me like I was a moron, and even asked me “why would anyone want to do that?” He also asked my girlfriend “where did you find this guy?” When he decided that I wasn’t a surgical candidate, and that he couldn’t make a quick buck off of me he told me that I have “generalized ligamentous laxity,” chronic patellofemoral syndrome, and that I should never deadlift or squat to depth again (to cover his own ass). He didn’t do shit with his physical exam, and didn’t even refer me to PT or anything. Basically gave me a big fuck you and shuffled me out the door.

I called a sports medicine complex that has PT and an orthopedic surgeon who specializes in sports medicine. He said I need to have a referral. I went to see my PCP and he said that since I am an athlete he wants to help me fix everything up so I can go back to what I love. I am scheduled for an MRI and am pending a referral to the complex that has the PT and sports med surgeon.

Any simple PT advice would be excellent at the moment.

I have done light squatting, bodyweight squatting, and exercise bike work to keep it moving. Is there anything else you guys recommend that I do while I wait for evaluation?

Thank you for all the responses![/quote]

Did the ortho give you any contraindications? I would be careful loading the knee until the MRI results come back. Full ligament ruptures can present painlessly so you should probably avoid heavy movements (not saying I think it’s a full rupture, but won’t hurt to wait a day or two to get the results).

Sounds like you found a real jackass. The worst part is you still have to pay him.

33

[quote]CroatianRage wrote:

[quote]trivium wrote:
Did everyone survive the night?

I went to visit an orthopedic surgeon. When I told him I lift weights, he treated me like I was a moron, and even asked me “why would anyone want to do that?” He also asked my girlfriend “where did you find this guy?” When he decided that I wasn’t a surgical candidate, and that he couldn’t make a quick buck off of me he told me that I have “generalized ligamentous laxity,” chronic patellofemoral syndrome, and that I should never deadlift or squat to depth again (to cover his own ass). He didn’t do shit with his physical exam, and didn’t even refer me to PT or anything. Basically gave me a big fuck you and shuffled me out the door.

I called a sports medicine complex that has PT and an orthopedic surgeon who specializes in sports medicine. He said I need to have a referral. I went to see my PCP and he said that since I am an athlete he wants to help me fix everything up so I can go back to what I love. I am scheduled for an MRI and am pending a referral to the complex that has the PT and sports med surgeon.

Any simple PT advice would be excellent at the moment.

I have done light squatting, bodyweight squatting, and exercise bike work to keep it moving. Is there anything else you guys recommend that I do while I wait for evaluation?

Thank you for all the responses![/quote]

Did the ortho give you any contraindications? I would be careful loading the knee until the MRI results come back. Full ligament ruptures can present painlessly so you should probably avoid heavy movements (not saying I think it’s a full rupture, but won’t hurt to wait a day or two to get the results).

Sounds like you found a real jackass. The worst part is you still have to pay him.
[/quote]

He just covered his own ass and basically told me to never lift again, and if I was going to when my knee started feeling better I should never bend more than 45 degrees on any squats or leg presses. I want to compete in powerlifting. This is not going to cut it.

I’m not saying I am a pro athlete, but what if I was? Would he have just told them to pack up and quit too? I mean seriously. He just saw that I wasn’t a quick fix, and covered his ass with anticipatory guidance, and shipped me out the door.

I am pretty pissed about having to pay him haha. I have my bachelors in health sciences and am working on my masters degree. I have done about a thousand hours of clinical rotations and I am sorry to say that I could have done a better exam and come up with a better treatment plan.

I came out of there knowing nothing more than I did walking in. No tests. No referrals to PT. Not even a script for some NSAIDS.

34

[quote]CroatianRage wrote:
Wow, this got out of hand quickly. I guess I’ll only address one point because, to be honest, I stopped reading.

Plenty of people have been injured from improper ice use (falling asleep with ice packs on). How many people know how to effectively apply ice? Most laypeople I’ve had experience with think the longer the better. If I tell a patient to ice their knees and they get injured because I didn’t explain exactly how, and document it, then I am absolutely liable for that injury.

Even proper NSAID use can cause death, although it is very rare.

Assuming you are a health care professional, then you’re wrong about someone asking for help and if they take your advice it’s on them.[/quote]

Please support your claim that plenty of people have been injured by ice, to my knowledge I am unaware of any literature not using vulnerable populations (post-op, less that 18, SCI), in which icing resulted in significant injury. What is the incidence of injury from icing? Keep in mind an isolated case reported is not a sufficient LOE. If you can find multiple case reports or a cohort on icing the shoulder resulting in localized frost bite I will reconsider my stance.

Medical professional? nope work at a desk, but I have worked in conjunction with them and am familiar with LOE.

35

[quote]BHOLL wrote:

[quote]CroatianRage wrote:
Wow, this got out of hand quickly. I guess I’ll only address one point because, to be honest, I stopped reading.

Plenty of people have been injured from improper ice use (falling asleep with ice packs on). How many people know how to effectively apply ice? Most laypeople I’ve had experience with think the longer the better. If I tell a patient to ice their knees and they get injured because I didn’t explain exactly how, and document it, then I am absolutely liable for that injury.

Even proper NSAID use can cause death, although it is very rare.

Assuming you are a health care professional, then you’re wrong about someone asking for help and if they take your advice it’s on them.[/quote]

Please support your claim that plenty of people have been injured by ice, to my knowledge I am unaware of any literature not using vulnerable populations (post-op, less that 18, SCI), in which icing resulted in significant injury. What is the incidence of injury from icing? Keep in mind an isolated case reported is not a sufficient LOE. If you can find multiple case reports or a cohort on icing the shoulder resulting in localized frost bite I will reconsider my stance.

Medical professional? nope work at a desk, but I have worked in conjunction with them and am familiar with LOE.
[/quote]

You don’t know he’s not a vulnerable population.

36

[quote]CroatianRage wrote:

[quote]BHOLL wrote:

[quote]CroatianRage wrote:
Wow, this got out of hand quickly. I guess I’ll only address one point because, to be honest, I stopped reading.

Plenty of people have been injured from improper ice use (falling asleep with ice packs on). How many people know how to effectively apply ice? Most laypeople I’ve had experience with think the longer the better. If I tell a patient to ice their knees and they get injured because I didn’t explain exactly how, and document it, then I am absolutely liable for that injury.

Even proper NSAID use can cause death, although it is very rare.

Assuming you are a health care professional, then you’re wrong about someone asking for help and if they take your advice it’s on them.[/quote]

Please support your claim that plenty of people have been injured by ice, to my knowledge I am unaware of any literature not using vulnerable populations (post-op, less that 18, SCI), in which icing resulted in significant injury. What is the incidence of injury from icing? Keep in mind an isolated case reported is not a sufficient LOE. If you can find multiple case reports or a cohort on icing the shoulder resulting in localized frost bite I will reconsider my stance.

Medical professional? nope work at a desk, but I have worked in conjunction with them and am familiar with LOE.
[/quote]

You don’t know he’s not a vulnerable population.
[/quote]

Again, you failed to cite any evidence on your stance. Just because you state ice is dangerous does not makeit factual. If you want to state your opinion on a matter that is fine, but if your going to particpate in debate then be prepared to back your statements. Vulnerable population or not I have yet to come across a single legitiment study or even a case study of localized frostbite of the shoulder. We can safely rule out post op btw. The fact that your even having this debate is astonishing.

37

[quote]BHOLL wrote:

Medical professional? nope work at a desk, but I have worked in conjunction with them and am familiar with LOE.
[/quote]

[quote]BHOLL wrote:

I dont know why this guy continually accuses me of being in the medical profession, I actually work in a cubicle all day lmao, I just like to exercise and read training methodology.
[/quote]

So he admits that he neither has formal training nor does he have real-world experience.

Check out this statement he made in a post from last year.

http://tnation.T-Nation.com/hub/BHOLL#myForums/thread/5805447/

[quote]BHOLL wrote:

[quote]StevenF wrote:
I’ve posted on here before about nagging golfer’s elbow pain and I’ve seen many people also have the same problem. I started going to a chiropractor right next to my gym a couple months ago. I was going for my nagging back pain issues which are all but non-existent now. I have squatted and deadlifted more than I ever have and pain free. But I also mentioned my forearm/elbow issue and he has this laser machine that they’ve used about 3x so far.

I’ve been doing chinups and pullups and curls pain free since those treatments! I have no idea what the laser is called but for the guys who have the same problem you may want to look into something like that. I’ve done a lot of massaging and finger extensions with the rubberbands as well but this treatment was the game changer. [/quote]

yup got it in my clinic

physio
[/quote]

READ THOSE LAST SEVEN WORDS

They sure do IMPLY that he is a PT or in the profession.

bholl - you just got busted for being a pretender with NO formal training and NO real-world experience in the subjects which you talk about.

Now I am absolutely convinced that your life is miserable and so devoid any actual accomplishment, that you spend all day surfing the net, collecting abstracts and quotes on a given subject, and come here to pontificate on your non-existent expertise.

38

[quote]BHOLL wrote:

[quote]CroatianRage wrote:

[quote]BHOLL wrote:

[quote]CroatianRage wrote:
Wow, this got out of hand quickly. I guess I’ll only address one point because, to be honest, I stopped reading.

Plenty of people have been injured from improper ice use (falling asleep with ice packs on). How many people know how to effectively apply ice? Most laypeople I’ve had experience with think the longer the better. If I tell a patient to ice their knees and they get injured because I didn’t explain exactly how, and document it, then I am absolutely liable for that injury.

Even proper NSAID use can cause death, although it is very rare.

Assuming you are a health care professional, then you’re wrong about someone asking for help and if they take your advice it’s on them.[/quote]

Please support your claim that plenty of people have been injured by ice, to my knowledge I am unaware of any literature not using vulnerable populations (post-op, less that 18, SCI), in which icing resulted in significant injury. What is the incidence of injury from icing? Keep in mind an isolated case reported is not a sufficient LOE. If you can find multiple case reports or a cohort on icing the shoulder resulting in localized frost bite I will reconsider my stance.

Medical professional? nope work at a desk, but I have worked in conjunction with them and am familiar with LOE.
[/quote]

You don’t know he’s not a vulnerable population.
[/quote]

Again, you failed to cite any evidence on your stance. Just because you state ice is dangerous does not makeit factual. If you want to state your opinion on a matter that is fine, but if your going to particpate in debate then be prepared to back your statements. Vulnerable population or not I have yet to come across a single legitiment study or even a case study of localized frostbite of the shoulder. We can safely rule out post op btw. The fact that your even having this debate is astonishing.
[/quote]

I don’t know of a single person in healthcare who would recommend ice without specific application instructions. We are all taught that ice is potentially dangerous. Your best case scenario for improper use of ice is the opposite desired physiological response–which is pretty bad. Increased blood flow to a swollen area seems like a bad idea.

The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner.
Nadler SF, Weingand K, Kruse RJ.
Author information
Abstract
Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculoskeletal injuries. Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Through a better understanding of these modalities, clinicians can optimize their present treatment strategies. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Continuous low-level cryotherapy and thermotherapy are newer concepts in therapeutic modalities. Both modalities provide significant pain relief with a low side-effect profile. Contrast therapy, which alternates between hot and cold treatment modalities, provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone. Complications of cryotherapy include nerve damage, frostbite, Raynaud’s phenomenon, cold-induced urticaria, and slowed wound healing. With thermotherapy, skin burns may occur, especially in patients with diabetes mellitus, multiple sclerosis, poor circulation, and spinal cord injuries. In individuals with rheumatoid arthritis, deep-heating modalities should be used with caution because increased inflammation may occur. Whirlpool and other types of hydrotherapy have caused infections of the skin, urogenital, and pulmonary systems. Additionally, ultrasound should not be used in patients with joint prostheses.

Notice the part about complications of cryotherapy. I apologize I used the nondescript word ‘plenty’ and it got your jimmies rustled. There are also ‘plenty’ of articles on pubmed if you search cryotherapy frostbite. I’m not interested in them because I know the standard of care for application of ice.

Personally, I think the only good use of ice is as an anesthetic. Seems silly to stop the inflammatory response in an injured tissue when that’s what’s directly responsible for healing it.

39

^^^CroatianRage, several days ago, we discussed the ramifications of, to put it in your words:

“…prescription from an online persona who is completely unaccountable to the patient…”

It’s abundantly clear bholl’s lacks the formal training and that his main skills are using his employer’s time and resources to google a given topic and argue the point to fulfill his fragile ego.

In other subforums, I’d simply ignore such behavior. However, because I’ve worked with so many people who have suffered injuries, I have the strongest of reservations against anyone pretending to be someone he’s not. Regardless how good someone’s online research and copy/paste skills may be, it absolutely does not - nor should it - replace first-hand knowledge.

It’s obviously up to you continue and debate your point with bholl. However, the fact that his only true agendas are NOT to get to the truth of the matter but simply argue his point, I respectfully ask that you factor this in.

Trivium - I realize this party was spoiled for a bit. If you want to continue to update your progress and get the opinions and theories of those who actually have the training and experience, feel free.

40

I also just asked some colleagues (DPTs) their opinion on the subject.

All of them agreed ice is to be applied a certain way.

One of them responded verbatim:

“Lol one of my prof that I didn’t like said the same thing and said u can put ice directly on the skin without adverse reactions so I did just to prove her wrong and got a huge welt on my leg haha”

^ Ice causing injury. But science is perfect and anecdotal evidence doesn’t matter, blah blah blah.

Haha, and right before I hit send! Another verbatim text just came in:

“I’ve had a pt that got it from falling asleep on a cold pack. -people are idiots sometimes-”

^ Ice causing injury.

Both of those responses are from DPTs.

You can pour over the literature all day, but these are real life situations in people who have been in practice for less than 3 years combined. I’m awaiting your comeback about how these are isolated anecdotal cases. Should a riveting read full of pubmed searches.